Pain Relief Flashcards
What are the three classes of analgesics
Non opioid
Opioid
Adjuvant
Eg non opioid analgesics
Paracetamol
NSAID
Eg opioid analgesics
Codeine
Morphine
EG adjuvants
Antidepressants
Antiepileptics
What are the two main considerations for moderate pain
Codeine phosphate
Tramadol hydrochloride
What is good for pain relief of bone mets
Radiotherapy
Bisphosphonates
Radioactive isotopes of strontium chloride
Main things used for nerve pain
Gabapentin or pregabalin
Pain caused by nerve compression
Dexamethasone
What are the two types of preparations of morphine
Immediate release
Modified release
How often is immediate release morphine usually given orally
4 hourly
How often is modified release morphine usually given orally
12 hourly
How do you treat breakthrough pain
Immediate release morphine as a rescue dose
When should an additional dose of morphine be given
30 minutes before an activity that causes pain
How do you calculate the dose of the opioid for breakthrough pain
1/10 to 1/6 of the regular 24 hour dose repeated every 2-4 hours as required
When is a review of pain mgt needed
If needing more than 2 rescue doses for breakthrough pain
How do you increase morphine
Increments Should not exceed 1/3 to 1/2 of the total daily dose every 24 hours
What is the usual dose required for patients on morphine
IR 30mg 4 hourly
Or
MR 100mg 12 hourly
What is the maximum a patient may require for morphine
IR 200mg 4 hourly
Or
MR 600mg 12 hourly
How to start morphine
Give immediate release 4 hourly first then once pain controlled switch to equivalent dose of modified release 12-24 hourly
What should be prescribed routinely with morphine
Laxative
What are the main side effects of morphine that should be monitored for
Constipation nausea and vomiting
What is used if a patient cannot tolerate morphine
Oxycodone hydrochloride
Are codeine and tramadol equivalent doses
Yes
How to convert codeine or tramadol to morphine oral
Morphine is a tenth of the dose orally
How to convert the oral morphine dose to IM IV or SC
Divide by 2 (half of the oral dose)
How to convert morphine to oxycodone
Oxycodone dose is equivalent to 2/3 of the morphine dose
How do you convert morphine to hydro morphone
Hydro morphine is a fifth of the dose of oral morphine
How to convert codeine to dihydrocodeine
It’s equivalent!
What are the two forms of morphine that can be given parenterallg
Morphine
Diamorphine
How to convert oral morphine dose to the equivalent diamorphine dose to be given subcut
1/3 of the oral dose of morphine
What pain relief can be given rectallu
Morphine
Oxycodone hydrochloride
What are the main types of pain relief that can be given transdermally
Fentanyl
Buprenorphine
If patients are on a transdermal patch what can be given for breakthrough pain
IR morphine
What are the three formulations of transdermal patches
72 hourly
96 hourly
7 day patches
How often are fentanyl patches on for
72 hours
What three drugs are contraindicated for use in syringe drivers
Chlorpromazine hydrochloride
Prochlorperazine
Diazepam
As the cause local irritation
(Cyclizine and levomepromazine can also cause this)
What is the usual infusion rate of a CSCI
0.1-0.3ml/hr
What is the units of most pain reliefs
mg
What type of morphine is given in a syringe driver and up to what max dose
Diamorphine (up to 250mg/ml)
How do you give breakthrough pain relief in a patient with a syringe driver
Subcut or IM equivalent to 1/10 to 1/6 of the total 24 hour subcut infusion dose
How do you minimise the risk of infection with syringe drivers
No subcut infusion solution should be used for longer than 24 hours
What is the usual dose of the paracetamol
0.5-1g every 4-6 hours (max4g/ day)
What is the dosage of paracetamol for people under 50kg o hepatotoxicity
15mg/kg every 4-6 hours
What is the other indication for paracetamol
Pyrexia
What are the two main cautions for paracetamol
Hepatotoxicity risk
Under 50kg
When else should doses of paracetamol be reduced
With xoadministration of enzyme inducing anti epileptic meds in can increase risk of toxicity so doses should be reduced
Paracetamol and EGFR less than 30
Make it 6 hours not 4
What is the oral suspension of paracetamol
120mg/5ml
250mg/5ml
500mg/5ml
What are the three preparations of cocodamol?
8/500
15/500
30/ 500
What is the maximum doses of cocodamol per day?
64/4000
120/4000
240/4000
What are the formulations of codeine
15mg 30mg 60mg
What is the usual dose of codeine phosphate for pain
30-60mg every 4 hours (max 240mg per day)
What drug should NOT be coprescribed with opioids
Benzos - can cause potentially fatal respiratory depression
What are the main contraindications of opioids
Acute resp depression Comatose patients Head injury Raised IcP Risk of paralytic ileus
What are common side effects of opioids (MORPHINE)
Miosis Out of it Resp depression Pruritus and pneumonia Hypotension and headache Infrequency (urinary retention and constipation) Nausea Emesis
Also arrhythmias and palpitations
Opioids in hepatic and renal impairment
Caution in hepatic impairment
Don’t use in renal impairment
What is the typical dose of tramadol
50-100mg every 4-6 hours (maximum dose is 400mg /24 hours)
What is the initial adult dose of morphine for acute pain
10mg every 4 hours
What is the usual dose for chronic pain
5-10mg every 4 hours
